What is an Intraarticular Steroid Injection?

Intraarticular steroid injections explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Foot ArthritisIntraarticular steroid injections are a procedure used to treat joint inflammation, reducing pain and swelling while increasing joint mobility. This treatment has been in use since the early 1950s and is used when over-the-counter medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), are ineffective in managing the pain and swelling.

Powerful anti-inflammatory steroids or corticosteroids are injected directly into a joint (intraarticularly), providing relief from swelling and associated joint pain. These injections can be performed on any joint such as in the fingers, hands, shoulders, knees, or hips. Intraarticular steroid injections are very rapid, safe, and effective outpatient procedures that can typically be completed in under 15 minutes.

How is an Intraarticular Steroid Injection Performed?

Procedure PreperationAs with any injection, the skin must be cleaned and sterilized. To help the physician guide the needle precisely to the desired location where the steroid will be administered, fluoroscopic or X-ray imaging may be used. A local anesthetic is used to numb the area for the procedure and during recovery. Most procedures are completed within 15 minutes.

Several steroidal medications with varying degrees of solubility are available such as prednisolone, hydrocortisone, methylprednisone, and multiple forms of triamcinolone. Solubility is an important factor that determines the duration and effectiveness of the steroid used. Because rapid clearance of the medication from the joint decreases its local effectiveness, less soluble compounds such as triamcinolone hexacetonide may be preferred.

For some patients, a non-steroidal compound such as hyaluronan or hyaluronic acid may be used. Hyaluronan is naturally occurring in various tissues and in the synovial fluid of joints. Hyaluronan provides lubrication and shock absorbent properties to the joint. This compound was approved by the FDA in 1997 for the treatment of osteoarthritis.

Patients should be aware of risks associated with any medical procedure. Although complications arising from intraarticular steroid injections are rare, risks include bleeding, infection, nerve damage, and tendon damage.

Conditions Related to Intraarticular Steroid Injections

Osteoarthritis in HandsIntraarticular steroid injections have been shown to be effective in the treatment of joint pain, swelling, and inflammation associated with osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint condition caused by the wear and tear of aging. As we age, the cartilage and cushioning of our joints breaks down and considerable pain and inflammation can occur. 80% of individuals over 65 years of age are affected by osteoarthritis to some degree and 30% of people are symptomatic by the age of 50. Intraarticular steroid injections can also be used to treat other types of arthritis such as psoriatic arthritis. It is also used to treat other inflammatory joint conditions such as gout and tendonitis.

A 52-patient, double-blind study conducted by Lambert et al. in 2007 focused on the effectiveness of intraarticular corticosteroid injections. In comparing a group of patients treated with triamcinolone to the group treated with saline (a placebo), they found significant improvement in the treated group even after three months. When considering the safety of this treatment, they noted that no increase in adverse side effects were reported by the patients receiving the treatment.

Although no significant adverse effects were noted in the study above, any procedure can have associated risks. Possible complications resulting from intraarticular steroid injections include infection, bleeding, and nerve or tendon damage.

Intraarticular steroid injections are considered after over-the-counter medications have been found to be ineffective in treating a patient’s joint pain and swelling. Initial medications used include NSAIDs, such as ibuprofen, aspirin, naproxen, and the analgesic acetaminophen. Not all patients respond favorably to these oral medications and some patients, such as those with chronic bleeding or ulcers, are advised not to use such medications. For these patients, intraarticular steroid injections may be a viable solution for joint inflammation.

Conclusion

Intraarticular steroid injections are safe, non-invasive, out-patient treatments used for a variety of inflammatory joint conditions including osteoarthritis, gout, and tendonitis. It is a commonly used procedure with a range of available medications. Patients typically experience dramatic pain relief for several months without any major side effects. Patients experiencing joint pain and swelling that is not well managed by oral medications may be candidates for intraarticular steroid injections.

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References

  1. Chavez-Chiang N, Sibbitt W, Band P, et al. The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee. Rheumatol Int. 2012; 32:513-518.
  2. Kruse D. Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe? Curr Rev Musculoskelet Med. 2008; 1(3-4):227-223.
  3. Lambert RGW, Hutchings EJ, Grace MGA, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip. A randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007; 56(7):2278–87.
  4. Lavelle W, Demers-Lavelle E, Lavelle L. Intraarticular Injections. Anesthesiology Clin. 2007; 25:853-862.
  5. Neustadt D. Intraarticular injection for osteoarthritis of the knee. Clev Clin J Med. 2006; 73(10):898-911.
  6. Pichler W, Weinberg AM, Grechenig S, et al. Intraarticular injection of the acromioclavicular joint. J Bone Joint Surg. 2009; 91(12):1638-1640.